The heart is the pump that keeps blood circulating throughout the body and thereby transports nutrients, breakdown products, antibodies, hormones, and gases to and from the tissues. The heart consists mostly of muscle; the myocardial cells (collectively termed the myocardium) are arranged in ways that set it apart from other types of muscle. The outstanding characteristics of the action of the heart are its contractility, which is the basis for its pumping action, and the rhythmicity of the contraction.

Heart muscle differs from its counterpart, skeletal muscle, in that it exhibits rhythmic contractions. The amount of blood pumped by the heart per minute (the cardiac output) varies to meet the metabolic needs of the peripheral tissues (muscle, kidney, brain, skin, liver, heart, and gastrointestinal tract). The cardiac output is determined by the contractile force developed by the muscle cells of the heart (myocytes), as well as by the frequency at which they are activated (rhythmicity). The factors affecting the frequency and force of heart muscle contraction are critical in determining the normal pumping performance of the heart and its response to changes in demand.

Structure and organization

The heart is a network of highly branched cardiac cells 110 μm in length and 15 μm in width, which are connected end to end by intercalated disks. The cells are organized into layers of myocardial tissue that are wrapped around the chambers of the heart. The contraction of the individual heart cells produces force and shortening in these bands of muscle, with a resultant decrease in the heart chamber size and the consequent ejection of the blood into the pulmonary and systemic vessels. Important components of each heart cell involved in excitation and metabolic recovery processes are the plasma membrane and transverse tubules in registration with the Z lines, the longitudinal sarcoplasmic reticulum and terminal cisternae, and the mitochondria. The thick (myosin) and thin (actin, troponin, and tropomyosin) protein filaments are arranged into contractile units (that is, the sarcomere extending from Z line to Z line) that have a characteristic cross-striated pattern similar to that seen in skeletal muscle.

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